AACN News—January 2005—Opinions

Vol. 22, No. 1, JANUARY 2005

President's Note

Live Your Contribution
Inside Somebody Else’s Skin

By Kathy McCauley, RN, PhD, BC, FAANPresident, AACN

Compassion is the sometimes-fatal capacity for feeling what it’s like to live inside somebody else’s skin. It is the knowledge that there can never be any peace and joy for me until there is peace and joy finally for you too.—Frederick Buechner

How would you respond to these familiar situations?• A young ICU patient nears the end of his life. His family can visit only for brief, prescribed periods, and end-of-life care has not been instituted.• A middle-aged woman, in severe pain because of her complex wounds, is losing hope.• An experienced nurse has decided that hiring new graduates is more trouble than it’s worth.• A nurse gives his entire career to critical care and wants to continue making a contribution, only he can’t sustain the same level of physical demands every time he works.

Nurses have their challenges these days. Yet, some things are going really well. For one, the public loves us. We’re the profession most trusted to act honestly and ethically—even more than firefighters, who held top ranking following 9-11. An interactive online Wall Street Journal Harris poll in January 2004 reported that 95% of Americans trust us to do the right thing for patients, higher than doctors, pharmacists and dentists. More recently, Gallup’s annual survey on the honesty and ethical standards of various professions placed nurses at the top of the list, ahead of grade school teachers and 12 points higher than physicians.

What Earns the Public’s Trust?I believe the compassion that nurses contribute to healthcare is what tips the scale. I’ve never bought into “doctors cure, nurses care” as the way to explain our contributions. I know many caring physicians. And, at times, nursing care can help to cure as much as any surgery or medication. Yet, nurses have an advantage—our intimate, involved and sustained contact with people when they are most vulnerable. That is when the public experiences our compassion and when we earn their trust.

The public links nurses’ compassion directly to healing. When Chicago’s Swedish Covenant Hospital surveyed healthcare consumers, it found that 95% agree compassion aids in the healing process, and 88% see it as an important or very important aspect of healthcare.

What Does Compassionate Care Look Like? Our contribution of compassion is inseparable from being fully present, something we considered in my October column. Compassion is more than being nice. Even more than being knowledgeable and competent. It is the way we truly live inside somebody else’s skin. The renowned acting teacher Stella Adler understood this. “Whose shoes are you wearing?” she challenged the aspiring actor. “Why, mmmine,” he stuttered. “Take them off and find another pair,” she directed. “You’ll never understand your role if you keep wearing your own shoes.”

Respondents to the Swedish Covenant survey called compassion “healthcare delivered with a personal touch.” Treating patients with dignity. Caring about them as people. Showing concern for their worries. Focusing on their special needs, including their culture, race and religious beliefs. Spending time with them. Collaborating to care for them.

Derailing or Setting the Course?Today, so much derails our best intentions of being compassionate. We often feel as if, to accomplish the basics, we need to nurse the system before we can nurse the patient. We face inept communication. Broken systems. Lip service to collaboration. Short staffing. Absent leadership. Unhealthy work environments. Being compassionate is grueling when we are treated harshly. Yet, sustaining compassion is essential for nursing to survive, let alone thrive. It is the quality that uniquely defines nurses’ contributions.Patients and families have everything to gain from our compassionate competence. It turns the most horrific illness into a life-changing experience, bringing families closer and uncovering resources people never knew they had. The healing energy of our compassion often drives that transformation.Compassion sets the course for how nurses respond to the familiar situations I described earlier. It allows us to treat each person with dignity, be fully present to uncover their unique needs, invest in meeting those needs, and care enough about them and their worries that we rally our colleagues to offer our best chance for a cure or peaceful death.

What’s in It for Us?Compassion that flows from us must come back to us. This reaffirms—as Frederick Buechner suggests in his book Wishful Thinking—our knowledge that “there can never be any peace and joy for me until there is peace and joy finally for you too.”We have chosen a tough profession. One where our lived contributions are needed today perhaps more than ever. Do nurses risk running out of compassion? Is that what burning out means? Compassion fatigue is a proven consequence of frequent, highly intense, stressful patients needing care. Overwhelmed by a constant flow of patients with devastating injuries, nurses become aloof, performing the tasks without being able to relate to the person injured. Some nurses experience nightmares and intrusive thoughts similar to victims of post-traumatic stress disorder.We reaffirm our choice of becoming a nurse and prevent our compassion from becoming fatal when we are supported in talking safely about our feelings, needs and fears. When we can use our talents to connect, to care and to truly make a difference, we are nourished in return. We receive the satisfaction that flows from making a critical illness the best experience it can be for a patient and family. To avoid or recover from the consequences of intense nursing requires a caring and compassionate healthcare team—managers, colleagues with counseling skills, each other. Their compassion isn’t optional. It is the essential and renewable resource we need in order to constantly give of ourselves.What is the role of compassion in your work as a nurse? Have you found that nursing without compassion isn’t even nursing? Or that, in troubled times like ours, being compassionate is risky behavior? I invite you to share your reflections and experiences so we can learn together how to live our contributions. Write to me at kathy.mccauley@aacn.org.